Bitter pills to swallow
Drug companies have a lot to answer for in regard to America’s opioid crisis.
News of America’s opioid epidemic inevitably reaches us in the form of numbers. Officially, there were nearly 50,000 opioid overdose deaths in 2017, from a total 72,000 fatal drug overdoses. One hundred and 75 Americans die of opioid overdoses on an average day – more than guns, more than cars, more than the Aids crisis at its worst. The two-decade epidemic will probably claim its millionth life within a couple of years.
Beth Macy takes a different approach in Dopesick – that of the local reporter, first for the Roanoke Times in Virginia, then covering the area for the New York Times. The centre of her book is the people she met first as a journalist – addicts, their families, doctors, even dealers. One victim stands out: Tess Henry, a high school poet, athlete and honour student who became addicted after being prescribed a month’s worth of pills for bronchitis pain in 2012, the year Macy began covering the epidemic. Henry was found dead in a dumpster, far from home on Christmas Eve 2017 – a murder victim rather than an official opioid death, but assuredly a casualty of the epidemic.
All the names and faces are Macy’s way of humanising the problem, but sometimes as a reader it’s difficult to share her intimacy with them. What is inescapable is the picture that emerges from these individual stories of sweeping systemic failure.
Early in the book, she quotes an emergency doctor comparing what was expected of him to his experience working in New Zealand hospitals, where pain and occupational injury were addressed with a variety of therapies. In the US, the managed-care system favoured a cheaper option: pills, and more pills. Pharmaceutical companies had already convinced regulators that their new synthetic painkillers would not make patients dependent, even when prescribed for chronic pain, and one in particular – Purdue Pharma – used elaborate marketing incentives to pump more and stronger pills into communities.
Even when the prescription crackdown finally came, regulators took little heed of the people who were already addicted and turned to heroin. A moral bias against maintenance treatment, demonstrably the most effective way of keeping addicts alive and getting them stable, led to the dominance of 12-step-style programmes that simply made failures of most of them. Users who’d been jailed for social dealing were released with no way back into society. Victims whose state legislatures rejected Obamacare’s Medicaid expansion fared worst. Nine out of 10 addicted Americans get no treatment at all.
Some of those issues apply in many countries, including here. But Dopesick is a story of the wrong things being done, over and over. The light in the story comes not from the top down, but from individual doctors, parents and local initiatives. Perhaps those things will eventually be the key to ending the plague. But that end seems a long way off yet.
One pharmaceutical company used elaborate marketing incentives to pump more and stronger pills into communities.